Provider Demographics
NPI:1578818001
Name:WILLIAMS, STEPHANIE L (MA, MS, MED)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BAINBRIDGE ST
Mailing Address - Street 2:P.O. BOX 40
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2403
Mailing Address - Country:US
Mailing Address - Phone:516-379-4904
Mailing Address - Fax:
Practice Address - Street 1:6 BAINBRIDE STREET
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-0040
Practice Address - Country:US
Practice Address - Phone:516-379-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist